The importance of diet is often overlooked in the treatment of patients with cancer
THE ARSENAL of weapons in the modern war against cancer is improving all the time. Irish patients with the disease now have chemotherapy, radiotherapy, biological and hormone therapies, and access to exciting new clinical trials.
However, one important weapon against cancer that is often neglected is the nutritional care of patients. Malnutrition is a significant public health issue which is estimated to affect 140,000 Irish adults at any one time at a cost of €1.5 billion annually, yet it remains underdetected and undertreated.
While it conjures up images of the skeletally thin and starving, it is quite common for people who are normal weight or even obese to be affected by malnutrition, which is a condition caused by a lack of essential nutrients.
“Recent research in Ireland shows that a third of people being admitted to hospital are at risk of malnutrition. This number is significantly higher in cancer patients, with up to 44 per cent of those being admitted to hospital at risk,” explains Julie Dowsett, a senior clinical dietitian and member of the board of the Irish Society for Parenteral and Enteral Nutrition (Ispen).
“It is often missed as disease-related malnutrition can occur in overweight and even obese people. In fact, three out of four patients at risk of malnutrition are in the normal or overweight weight range,” says Dowsett.
Founded with the support of the Irish Society of Gastroenterology, the Irish Nutrition and Dietetic Institute and the Irish section of the Nutrition Society, Ispen is made up of clinicians, dietitians, nutritionists and other health professionals from clinical practice, research and education, whose aim is to combat malnutrition by optimising the nutritional management of patients in hospital and the community.
Eating problems in cancer patients can depend on many factors such as the type of cancer and treatment, and the number and dose of treatments, which can affect how a patient chews, swallows and absorbs food.
Common eating problems are loss of appetite, dry or sore mouth, taste and smell changes, difficulty swallowing, nausea and vomiting, diarrhoea and constipation.
Dowsett highlights the importance of having a dietitian as a member of the multidisciplinary cancer care team and involved at every stage of a person’s illness.
A nutrition screening tool can help identify a person at risk of malnutrition and initiate a treatment plan. People with all stages and types of cancer can benefit from nutritional advice expertly tailored to meet their individual needs to maximise their quality of life.
“We need greater awareness of the risk of disease-related malnutrition and the importance of the involvement of a nutritionist among doctors and nurses because this condition is often hidden,” says Dowsett.
“Malnutrition is preventable and also treatable if identified early, and nutritional treatment should be individually prescribed as part of the patient’s overall treatment plan.”
There are nutritional treatments which can improve every stage of the disease, explains Dowsett, even the very end stage when quality of life may be all that is left to a patient.
While it is normal for cancer patients to lose weight and feel unwell, she points out that the extent of this can be reduced through proper nutritional management.
Prof John Reynolds, a consultant gastrointestinal surgeon with special interest in oesophageal cancer at St James’s hospital in Dublin and chairman of Ispen, stresses how vital it is that cancer patients get adequate access to good dietary management, not only as inpatients but when they go back home.
“A nutritionist who understands the dietary and nutritional needs of these patients and has a day-to-day involvement with them has a hugely important and central role in the multidisciplinary cancer care teams, particularly in cancers associated with malnutrition such as oesophageal, stomach and pancreatic cancer, and cancers of the voicebox and neck,” he says.
A high percentage of patients with gastrointestinal cancer – at least one in three – are malnourished, according to Reynolds. It is also a big issue in lung cancer patients, particularly those who smoke.
He points out that many of the treatments cancer patients are put through are very demanding on their nutritional reserves, taste and appetite, and they can often run into severe nutritional difficulties that go on over months.
“In St James’s, we have fantastic dietitians who work with our cancer patients, but there is a real deficiency in terms of numbers in this specialty and there is a crying need for more around the country,” says Reynolds.
“This is so important for the well- being, quality of life and survival of cancer patients, but it’s an area that is not given enough weight in terms of health service provision.
“The nutritional side of things is being completely and utterly ignored, despite the fact that we know that an element of nutritional support gives a patient a better chance of a successful outcome from surgery and other treatments.”
10 WAYS YOU CAN PREVENT CANCER
The World Cancer Research Fund believes that at least one-third of cancers can be prevented by eating the right food, taking regular exercise and avoiding obesity. It suggests the following 10 things to do to prevent cancer and its recurrence:
1. Be as lean as possible without becoming underweight.
2. Be physically active for at least 30 minutes every day.
3. Avoid sugary drinks. Limit processed foods that are high in added sugar or low in fibre or high in fat.
4. Eat a variety of fruit and vegetables, wholegrains and pulses (beans, peas).
5. Limit the amount of red meat (beef, pork, lamb) you eat. Eat no more than 500g of cooked meat per week. Avoid processed meats (some sausages, black and white pudding, bacon, ham, cornbeef, salami).
6. Drink less alcohol. Limit it to two drinks for men and one drink for women a day. Have a few days free of alcohol each week.
7. Eat less salty foods, especially processed products.
8. Avoid dietary supplements if you have a balanced diet. However, some people may need supplements as advised by their doctor or dietitian.
9. Mothers should breastfeed fully for up to six months and then add other liquids and foods.
10. Cancer survivors should follow the guidelines for cancer prevention. Also, get advice about your diet from a professional dietitian. Remember do not chew or smoke tobacco.
This information is taken from the Irish Cancer Society’s Diet and Cancer booklet which is available for download at iti.ms/wNVq1w
